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Ovarian cyst removal

Ovarian cysts are fluid-filled sacs (pockets) that can grow inside or on the surface of your ovaries. They are usually removed using a surgical procedure called laparoscopy (keyhole surgery), but you may need open surgery.

You’ll meet the gynaecologist carrying out your procedure to discuss your care. A gynaecologist is a doctor who specialises in women’s reproductive health. Your care may differ from what we’ve described here as it will be designed to meet your own needs.

Ovarian cysts are common in women of childbearing age. Most ovarian cysts are harmless and go away on their own. However, you may need surgery to remove a cyst if you have one that’s causing you pain or discomfort, or if it may be cancerous.

Details

Your gynaecologist will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop. This is because smoking increases your risk of getting a chest or wound infection, which can slow your recovery.

Ovarian cysts are usually removed as a day-case procedure, which means you can go home the same day as you have the procedure. The operation is done under general anaesthesia – this means you’ll be asleep during the procedure. You’ll be asked not to eat or drink anything for about six hours beforehand. You may also be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.

Your gynaecologist will discuss with you what will happen before, during and after your procedure, and any pain you might have. If you’re unsure about anything, ask. No question is too small. Being fully informed will help you feel more at ease. You’ll need to give your consent for the procedure to go ahead by signing a consent form.

If the cyst isn’t causing any symptoms, your gynaecologist may suggest simply keeping an eye on it and, for the time being, doing nothing. This is called watchful waiting. You’ll be asked to attend regular ultrasound scan appointments to check whether the cyst changes size. Most ovarian cysts are likely to go away on their own within a couple of months.

Your gynaecologist will make two or three small cuts (about 1cm long). One near your belly button and two lower down, usually one on each side. He or she will pass small instruments and a tube-like telescopic camera (called a laparoscope) through the cuts. This procedure is known as laparoscopy, or keyhole surgery. Your gynaecologist will then examine your ovaries and remove the cyst. The cuts on your skin are closed with dissolvable stitches.

There’s a chance that your gynaecologist may need to change your keyhole procedure to open surgery. This is when a single, large cut is made in your lower abdomen to reach your ovary. This will only happen if he or she is unable to complete the operation safely using just keyhole surgery.

Simple cysts can usually be removed by keyhole surgery and every effort will be made to only remove the cyst – not your ovary. However, if there’s a chance that the cyst may be cancerous, your whole ovary may be removed. This is done by open surgery. If you’re diagnosed with cancer, you might need further surgery to remove as much of the cancer as possible. For example, you may need your womb removed. Your doctor will always discuss with you any major surgery they need to do before they do it.

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You’ll need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You’ll usually be able to go home when you feel ready. Arrange for someone to drive you home and try to have a friend or relative stay with you for the first 24 hours after your operation. General anaesthesia temporarily affects your co-ordination and reasoning skills, so don’t drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards.

Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure, they usually disappear in about two to three weeks.

You’ll usually feel well enough to go back to your normal activities one to three weeks after the procedure. The time it takes to recover will depend on whether you had keyhole or open surgery. It's important to follow your gynaecologist's advice; they will be able to tell you a realistic recovery time depending on your personal circumstances.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

All medical procedures come with some risk. But how these risks apply to you will be different to how they apply to others. Be sure to ask for more information if you have any concerns.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

After keyhole surgery, you’ll have some bruising and pain in your abdomen. You may also have some pain in the tips of your shoulders. The pain in your shoulders is known as referred pain and usually improves within 48 hours.

Complications

Complications are when problems occur during or after the operation. The possible complications of any operation include:

an unexpected reaction to the anaesthetic

an infection

excessive bleeding or developing a blood clot, usually in a vein in your leg (deep vein thrombosis – DVT)

Specific complications of ovarian cyst removal are uncommon, but can include damage to other organs in your abdomen. For example, your bowel, bladder, womb, one or both of your ovaries, or fallopian tubes.

You should contact your doctor if you develop symptoms such as:

severe lower abdominal pain or swelling

a high temperature

dark or unpleasant smelling vaginal discharge

red or painful skin around your scars

burning or stinging when you pass urine, or passing urine more frequently

pain, swelling, redness or a feeling of heat on your legs

If you have these symptoms, it’s possible you may have developed an infection and will need treatment. If you experience any unusual leg symptoms, seek urgent medical help.

I'm pregnant and have an ovarian cyst. Can it be removed?

Answer

An ovarian cyst is unlikely to cause harm to your baby during pregnancy. Your gynaecologist will only advise you to have the cyst removed if it's causing you pain or there’s a risk of it being cancerous.

Explanation

Ovarian cysts are usually harmless, slow-growing and go away on their own without treatment. If you’re pregnant and have an ovarian cyst, your gynaecologist will usually wait until you're 14 weeks pregnant before considering whether to remove it.

You won’t need any treatment if the cyst isn’t causing you any pain or discomfort, and there’s nothing to suggest that it may be cancerous. Your gynaecologist will monitor the cyst with regular ultrasound scans instead. This is called watchful waiting.

If the cyst causes you pain or shows signs of being cancerous, your gynaecologist will recommend having keyhole surgery to remove it. Keyhole surgery is safe to perform during pregnancy, but as with every procedure, there are some risks associated with it. Your gynaecologist will explain these risks to you.

Can I use contraception after I've had surgery for ovarian cysts?

Answer

Yes, although you should discuss methods of contraception with your GP first to find out which one is most suitable for you.

Explanation

If you’ve had an ovarian cyst removed, there’s no reason why you can't use contraception immediately after surgery.

Ovarian cysts are fluid-filled sacs (pockets) that can grow on the surface of your ovaries after an egg is released. The oral contraceptive pill stops your ovaries from releasing an egg and therefore reduces the risk of you having ovarian cysts. For this reason, your doctor may suggest using this method of contraception.

The oral contraceptive pill isn’t suitable for everyone. Your GP will be able to advise which type of contraceptive is best for you.

I need to have one of my ovaries removed. Am I still fertile?

Answer

Yes. You can still conceive with one ovary if your remaining ovary is functioning normally.

Explanation

The medical term for the removal of an ovary is oophorectomy. Salpingo-oophorectomy is the removal of your fallopian tube and ovary. You may have both your ovary and fallopian tube, or just your ovary removed, if the cyst is cancerous or there is significant damage. This may be because your ovary has twisted (torsion) or ruptured.

If only one of your ovaries is removed, your body can still produce oestrogen and therefore you’re still fertile. If both of your ovaries are removed (a bilateral oophorectomy), then your body will no longer produce oestrogen. This means you’ll go into early menopause and therefore won’t be able to conceive.

Talk to your gynaecologist if you’re at all worried about your fertility, especially if you’re planning to have children in the future, or plan to have more.

Ovarian cysts in pregnancy. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published July 2013

Guidelines for the diagnosis, treatment and use of laparoscopy for surgical problems during pregnancy. Society of American Gastrointestinal and Endoscopic Gynaecologists (SAGES). www.sages.org, published January 2011

Benign ovarian masses. The Merck Manuals. www.merckmanuals.com, published September 2013

Ovarian cysts before the menopause. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published July 2013

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